HomeMy WebLinkAboutMortgage_Fougnies�ei '( STATEMENT OF MORTGAGE OR CONTRACT INDtBTEDNESS
s' FOR DEDUCTION FROM ASSESSED VALUATION CoTunt Township Year
J Sia�e Fortn 43709 (R6 / 5-06) g
� Presaibed by Deparimem of Loml Gwemment Finance � ��
� �
INSTRUCTIONS: NOV 1 5 ��a�
To be filed in person o� by mail with the CountyAudito� of the county where the property is located.
Frfing Dates: 1J Real Property: Dunng the,72 months befo2 ,lune U o( the. year the deduction is to be �re.,G�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/t����the�� 7Y AuDITOR eflective.
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See reverse side for additional instructions and qualifications.
Applicant
buyer;
�'G /d� D % /
Assessed value of real property as of
March 1, cunent year
reverse side)�
� numberslegal scription
aoo. �_o��
Mortgage / Contrad indebtedness
March 1, curtent year
Record
Pagenumber� ��
as of _ 1s the applicant the sole legal or equitable
ownef? ` ❑ Yes ❑ No ' �
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than ihat of applicant, indicate below: � � � /. � S 7� —
Dra��•er NO•• . ... .....
�-
�e of mortgagee or contrad il,er/
�/Y`�.: - .• Card NO . ..................
Addresa of mortgagee or contrad selier (number.and street, city; state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and stieet, city, state, ZIP code)
Does applitant own property in any other I If yes, what county? What Taxing Dislrid?
county in Indiana?
Deduction approved in the amount
Za P I zo
Signature _
�
COUNTY AUDITOR
2� 2� 2�
County Auditor
Has this dedudion been requested on
property for current yeaR� Yes❑ No
20
Date
20
certify under the penalty of perjury lhat the above and foregoing informalion is true and corred and that the applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
/ull
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person